Tongue Tie

How your tongue is attached to the floor of the mouth plays a significant role in how your face grows and how your mouth functions through breathing, speech, and swallowing.

 

An emerging definition

For many years we have used a single method for identifying tongue tie (ankyloglossia). Over the last decade, that definition has been built upon as we have had a greater understanding of how the frenulum, fascia, muscle attachment, and mobility affect normal function.

Current Definition

The IAAP (International Affiliation of Tongue-Tie Professionals) defines “tongue-tie” as an embryological remnant of tissue in the midline between the undersurface of the tongue and the floor of the mouth that restricts normal tongue movement.

We currently describe ‘tongue tie’ or ‘tongue restriction’ in 5 dimensions:

  • How far you can stick out the tongue

  • How far you lift the tongue up to the incisive papilla, ”the spot” (just behind the upper back teeth with mouth open)

  • How far you can open your mouth while your tongue is fully suctioned to the roof of your mouth

  • How much the floor of the mouth, neck, and other muscles help you to suction your tongue or lift your tongue to the spot

  • Muscle tension caused by the first three

 
image from RDH magazine Sept 2022
 

How we assess

When you meet with your myofunctional therapist, Dave Henrichsen, he will take several measurements of your tongue’s range of motion and discuss any restrictions you may have. If a tongue tie release is recommended, he will refer you to a highly qualified surgeon who has taken additional training in tongue tie assessment and treatment to release the tissues that are holding you back from normal function.

The tongue tie release will be done mid-therapy after you have developed muscle tone and coordination with the muscles around the frenulum. Once the release is completed, we will work together to develop the tone, coordination, and function of the newly released tongue and work towards optimal oral muscle function.

 

What about younger children and infants?

Myofunctional therapy can be very beneficial for younger children and their families. Currently, Dave is only working with children aged 7 and older. If your child is younger than 7, send Dave a text message and he can recommend other local myofunctional therapists that can treat your younger children.

Infancy is the best time to treat myofunctional disorders. If you are a family member or friend of a newborn baby, look for these symptoms:

  • Acting irritable or fussy during or after feeding

  • Having difficulty creating a secure latch during nursing

  • Losing weight or having poor weight gain

  • Forming blisters or cracks on their lips

  • Acid reflux or frequently spitting up after feedings

  • Colic or overall fussiness

  • Breast pain, cracked or blistered nipples

  • Plugged milk ducts (which can lead to mastitis)

  • Engorgement

  • Your baby falling off the breast frequently during nursing

  • A feeling that your infant is chewing or biting on the breast

This can be a very stressful and challenging time for families of newborns. If you notice any of these symptoms in your newborn, I recommend an immediate assessment by Dr. James Thomas at Health:Latch (healthlatch.com). He has an office location in Bellevue that specializes in infants aged 5 months and younger. He also has a great online tool called an intuition builder, which can help you connect with resources that will help you during this challenging time. This is a key time to treat myofunctional disorders so that we may avoid needing Dave’s help in the future!

Does it seem like there is more tongue tie today than in the past?

Several factors are leading to a renewed interest in tongue ties:

  • An increased focus on the benefits of breastfeeding in the 1990s led many parents to search for answers to challenges such as poor latch, painful nursing, insufficient milk intake, and the need for constant nursing.

  • A newer hypothesis that has emerged in the last several years talks about the increased use of folic acid starting in the 1980s to effectively prevent birth defects may have had the unintended consequence of a thickening of structures at the midline of the body, including tongue and lip ties.

  • In 1999 and 2004, the medical community was introduced to the idea that a tongue does not need to extend all the way to the tip to cause problems in feeding, growth, and development. Since then, several case reports and large research studies have described a posterior tongue tie or posterior tongue restriction that can cause problems in babies and children, which become progressively worse as those children grow up into adults.

  • Our society’s ability to communicate with many diverse communities allow individuals with symptoms that were previously unable to find underlying causes are now able to find that information for themselves.

  • The continued advancement of communication and educational technology allows healthcare providers to seek out and find answers to problems their patients are experiencing, and then share the successes and failures with those treatments.

  • Healthcare providers finding success in treating patients are willing to share that knowledge with other providers through easy to access learning libraries, social media, digital courses, and written materials, increasing access to this information at an accelerated pace. In the past, the sharing of knowledge was often limited to the immediate area. Now, practitioners are able to learn from other healthcare providers in Alabama, Oregon, California, Ireland, Australia, and other areas around the world from their homes or offices, reducing the need to travel around the world to find world class education in current medical trends.

The increase in knowledge and awareness does not explain the whole story as to why tongue tie has increased. Genetic and epigenetic causes may have additional explanations as to why it is more prevalent in our communities. Genetic mutations over the last century coupled with a change in lifestyle, diet, exposure to chemicals, and radiation has an impact on the DNA that is passed from one generation to the next. Those gene mutations can be passed along to children and may have led to a larger prevalence of tongue tie in the population. We cannot go back and do studies on the tissue, but several researchers have studied the bones of previous populations and we can conclude that the tongue restrictions that lead to our living generations dental malocclusion and smaller airway may not have been so prevalent.

Additional Reading

For additional information, I recommend you check out the website of one of the world leaders in tongue tie research, Dr. Zaghi at https://www.zaghimd.com/tongue-tie.